What is the initial treatment for a patient with partial thickness burns?

Initial Treatment for Partial Thickness Burns

Apply petrolatum or petrolatum-based antibiotic ointment (such as bacitracin, Polysporin, or triple-antibiotic ointment) as first-line treatment, covered with a clean non-adherent dressing, after immediate cooling with running water for 5-20 minutes. 1

Immediate Initial Actions

Cooling the burn:

• Cool the burn immediately with clean running water for 5-20 minutes to limit tissue damage and reduce pain 1, 2
• Monitor preadolescent children for signs of hypothermia during the cooling process 2
• Never apply ice directly to burns—this causes additional tissue damage 1, 2

Preparation of the wound:

• Remove all jewelry from the affected area before swelling occurs to prevent vascular compromise 1, 2
• Gently cleanse the wound with tap water, isotonic saline, or antiseptic solution 1, 3

Topical Treatment Protocol

First-line topical agent:

• Petrolatum-based antibiotic ointment is the preferred first-line treatment, promoting faster reepithelialization and reduced scar formation 1
• Acceptable options include triple-antibiotic ointment (bacitracin, neomycin sulfate, polymyxin B), bacitracin alone, or Polysporin 3, 2
• Apply a thin layer directly to the open burn wound 1, 3

Alternative agents (when appropriate):

• Honey shows benefit for infection resolution and reduced hypertrophic scarring, with decreased mean healing time of 7.8 days compared to silver sulfadiazine 1
• Aloe vera may be reasonable for small burns managed at home 1

Dressing Application

Non-adherent dressing options:

• Cover with a clean, non-adherent dressing after applying the topical agent 1, 2
• Xeroform (petrolatum-impregnated gauze) provides a non-adherent barrier while allowing exudate passage 3
• Mepitel (silicone-coated dressing) minimizes trauma and pain during dressing changes 3
• Allevyn (polyurethane foam) provides absorption and maintains moist wound environment 3
• Clean gauze can serve as a secondary dressing over the primary non-adherent layer 3

Dressing change frequency:

• Change dressings daily or as needed 1

Pain Management

• Administer over-the-counter analgesics such as acetaminophen or NSAIDs for pain control 1, 2

Critical Pitfalls to Avoid

What NOT to use:

• Do not use silver sulfadiazine as first-line therapy—it delays healing and worsens scarring compared to petrolatum-based treatments 1
• Silver sulfadiazine can cause transient leukopenia with maximal white blood cell depression occurring within 2-4 days, and may cause delayed wound separation requiring escharotomy 4

What NOT to do:

• Do not break intact blisters—this significantly increases infection risk 1, 2
• Do not apply butter, oil, or other home remedies, which exacerbate the injury 1, 3, 2

Special safety consideration:

• When treating facial burns in patients on oxygen therapy, avoid oil-based emollients near the nostrils due to combustion risk in oxygen-enriched environments (petrolatum-based antibiotic ointments remain safe) 2

Mandatory Referral Criteria

Immediate specialized burn center evaluation required for:

• All partial-thickness burns involving the face, hands, feet, or genitals—regardless of size—due to high risk of functional disability and cosmetic deformity 1, 3, 2
• Burns greater than 10% total body surface area in adults (>5% in children) 1, 2
• Signs of inhalation injury (soot around nose/mouth, difficulty breathing) 1, 2
• Circumferential burns 1
• Blue, purple, or pale extremities indicating vascular compromise 1